Provider Demographics
NPI:1841327178
Name:BROWN, LAWRENCE STEPHEN (DPM)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:BROWN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 VAN DYKE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1834
Mailing Address - Country:US
Mailing Address - Phone:586-758-5770
Mailing Address - Fax:
Practice Address - Street 1:25511 VAN DYKE AVE STE 100
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1834
Practice Address - Country:US
Practice Address - Phone:586-758-5770
Practice Address - Fax:586-758-6134
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB001169213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1582358Medicaid
MIT34160Medicare UPIN